The putative glymphatic signature of chronic fatigue syndrome: a new view on the disease pathogenesis and therapy
Abstract
The underlying pathophysiology of chronic fatigue syndrome remains incompletely understood and there are no curative treatments for this disorder at present. However, increasing neuroimaging evidence indicates that functional and structural abnormalities exist in the brains of chronic fatigue syndrome patients, suggesting that the central nervous system is involved in this disorder and that at least some chronic fatigue syndrome patients may have an underlying neurological basis for their illness. In the present paper, we speculate that glymphatic dysfunction, causing toxic build up within the central nervous system, may be responsible for at least some cases of chronic fatigue syndrome. We further postulate that cerebrospinal fluid diversion such as lumboperitoneal shunting may be beneficial to this subgroup of patients by restoring glymphatic transport and waste removal from the brain. Although recent evidence indicates that at least some chronic fatigue syndrome patients may benefit from cerebrospinal fluid drainage, further studies are needed to confirm this finding and to determine whether this can be attributed to enhancement of glymphatic fluid flow and interstitial fluid clearance. If confirmed, this could offer promising avenues for the future treatment of chronic fatigue syndrome. Clearly, given the relative invasive nature of cerebrospinal fluid diversion, such procedures should be reserved for chronic fatigue syndrome patients who are severely debilitated, or for those with severe headaches. Anyhow, it seems worthwhile to make every effort to identify new therapies for patients who suffer from this devastating disease, especially given that there are currently no effective treatments for this condition.
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More recent studies have found abnormalities in cerebrospinal fluid independent of psychiatric diagnoses, consistent with neuroinflammation.
“More recent studies have found abnormalities in cerebrospinal fluid independent of psychiatric diagnoses64–66, consistent with neuroinflammation.”
From Leveraging Prior Knowledge of Endocrine Immune Regulation in the Therapeutically-relevant Phenotyping of Women with Chronic Fatigue Syndrome (2019) · cites this paper as [64]
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- Authors
- Wostyn, P., & De Deyn, P. P.
- Corresponding author
- Wostyn, Peter
- ORCID
- Wostyn, Peter
- Venue
- Medical Hypotheses
- Publisher
- Elsevier BV
- Published
- 2018-09
- Volume
- 118
- Pages
- 142-145
- ISSN
- 0306-9877 (ISSN-L)
- OpenAlex
- W2848834207
- Cited by
- 27
- References
- 34
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 2 · 2020: 1 · 2019: 5 · 2018: 1
- FWCI
- 1.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Hypotheses (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Cerebrospinal fluid and hydrocephalus
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- chronic fatigue syndrome, glymphatic system, cerebrospinal fluid shunting, lumboperitoneal shunt, brain waste clearance, interstitial fluid clearance, neuroimaging abnormalities, central nervous system involvement, pathogenesis, treatment
- MeSH terms
- Biological Transport, Brain, Cerebrospinal Fluid, Drainage, Headache, Humans, Hydrocephalus, Lymph Nodes, Models, Theoretical, Fatigue Syndrome, Chronic, Extracellular Fluid
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